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10/30./2003 11:19 FAX U001 <br /> DATE RECEIVED EHD LOG NUMBER. <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT. <br /> T 3 0 2003 304 E Weber Ave 3"'Floor Stockton, CA 95205 <br /> (209)468-3420 Fax: (209)464-0138 Web: www.co.san-joaquin.ca.us/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: <br /> �jr 7-T- /Q /� BUSINESSIAGENCY::�� �V64- 4 FNyI/Z{�1/�l%d�f s7L <br /> ADDRESS: 3�//f L��t`7ITG�� C ��I- ('1GIVG' .SLt/f /� L-IJCJ� J`RvC2tlMfNl`fl C/9 QS�7Q <br /> PHONE: U IJJ ��5 FACSIMILE: C/A �/r�QZ <br /> TENTATIVE'APPOINTMENT DATE: �"�V /�7H 2CU3 Time: 104 <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$933..010 FE REQUEST PROCESSED IN 3 BUSINESS DAYS / ?? <br /> SIGNATURE OF APPLICANT /" DATE / y <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> 1. street 29 I ,V MMW Ntx= P?l vt city ST(It 7-UrJ ❑ Unit 1 <br /> 2. street ' 0 W%-Si /AJ '- 0$I W city rMk- +^17 4 <br /> 3. street Cil ❑ Unit 2 <br /> 4. street Cit <br /> 5. Street Gt ❑ U \\ ,r> fni� <br /> 6. Stroel city <br /> 7. Street Cd Un <br /> e. Street Cil <br /> 9. Street City Unit 5 <br /> 10, Street Cit <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten(10)days after receipt of application. The files <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new <br /> application may be submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> S. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHO 4&02-006 <br /> 3=203 <br />